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With Federal Threats Looming, States Should Protect and Improve Medicaid Family Planning Services

States Should Safeguard and Expand Choice of Services, Choice of Providers and Eligibility for Coverage

The Trump administration and conservatives in Congress are seeking to restructure the Medicaid program in ways that would severely undermine coverage—including coverage of family planning services—for millions of low-income individuals. To protect their residents’ continued access to these crucial services, state legislatures and Medicaid agencies should preserve and strengthen current Medicaid family planning protections, argues a new Guttmacher Policy Review analysis.

Medicaid is a critical safety-net program that provides coverage for one in five American women of reproductive age, including nearly half of those living below the federal poverty level. Because of its significant reach, the program accounts for three out of every four public dollars spent on family planning nationwide.

“Family planning care promotes the health and the social and economic well-being of women, families and society,” says Adam Sonfield, author of the new analysis. “States should take every action possible to protect and improve coverage of these services under Medicaid—regardless of what Congress and the Trump administration may do.”

Sonfield lays out a range of protective steps that state legislatures and state Medicaid agencies should take to bolster Medicaid family planning services, broken down into three broad categories:

Choice of services: States should require that Medicaid enrollees receive coverage for all needed care, including the full range of contraceptive methods, services and related preventive care. Another key step would be to codify and strengthen current federal prohibitions on cost-sharing and other administrative barriers to family planning, in order to ensure that enrollees are free from financial coercion. States should also bolster protections for patient confidentiality.

Choice of providers: Important safeguards include setting strong standards to ensure that plans include family planning providers in their network, while maintaining the federal protection that allows enrollees to choose any qualified family planning provider, even if that provider is outside of their network. Further, states should protect family planning providers from discrimination in their ability to participate in Medicaid and set sufficient reimbursement rates to cover the full cost of quality care. Sonfield also recommends that states revise their Medicaid policies to ensure that no patient is denied services because of a particular plan’s or provider’s religious objection to covering or providing that care.

Eligibility for coverage: Sonfield recommends that the 19 states that have not yet expanded Medicaid under the Affordable Care Act do so, thereby providing coverage to millions of currently uninsured people. States should also expand Medicaid eligibility for family planning services specifically to individuals who are otherwise ineligible for Medicaid. And states should refuse any new federal options that would restrict eligibility for the Medicaid program, such as through work requirements or lifetime limits.

“Medicaid is absolutely critical to the health and well-being of low-income people, and family planning services in turn are critical to achieving the central goals of the Medicaid program,” says Sonfield. “Current proposals to essentially gut Medicaid or otherwise drastically scale back its reach are alarming. States should act now to mitigate the potential harm and to further bolster the health of their residents.”

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